The God Delusion

Last time I was on call at the VA, we were called at 5:30am for a rapid response on a patient with lymphoma that had compressed his spinal cord and made him a paraplegic in a matter of weeks. Just that morning his family had made him a DNR. When we saw him he was relatively unresponsive but would respond to touch and shake his head when we asked if he was in pain. The nurse told me that his wife was coming back soon with other family members and that after 58 years she had finally convinced her husband to be baptized that morning. We stabilized his blood pressure and went to rounds. Later that morning I found out the patient had died, but first he had woken up just long enough to be baptized.

I'm glad for the patient's wife and family that they can get comfort from the thought that he was saved in his last moments of life. I wonder how the patient himself felt and if he got any comfort thinking he was going to God. At least he was surrounded by his family. Not that there's any harm in a little water splashed on your head if you don't believe it's anything but water...though some people could certain take offense, and with good reason. It reminded me of a recent interview I saw with Christopher Hitchens where he says that any future remarks that make it sound as though he had found religion would not truly be from him, but would rather represent the ravings of a dying man. Stick with your principles to the end. I'm hoping to finish reading "The God Delusion" as soon as I have a little free time (you know, when I've finished my sub-I, pediatric residency applications, research project, and "The Girl Who Played With Fire").

I've never been quite as militantly atheistic as Christopher Hitchens, I belong more to the school of everyone's free to believe whatever they want. Having said that (which I can't say without thinking of Curb Your Enthusiasm), I find it impossible to relate to anyone with strong religious beliefs. I certainly respect faith and think that good things can come out of it, but at some underlying level our world views are just completely irreconcilable. I'm not going to go out and name the second chapter of a book "Religion Kills", but at least from my observations in the hospital, may be in can. We had one patient who had been in the hospital for about a week with meningitis and thrombocytopenia. His platelet level was 4000 (anything under 150,000 is too low). With platelets that low if you hit your head on a cabinet or trip and fall you have going to bleed into you brain and die, no question. He was in the middle of his treatment but just got fed up with being in the hospital and decided to leave against medical advice. Our attending did everything he could to talk him in to staying, but the patient had decided that he was in God's hands and through the power of prayer he would be healed and if not then it was meant to be. He left. We've tried to follow-up with him since, but he lives alone and no one picked up the phone at his house. Hopefully he's still alive. He was deemed competent so he's allowed to make all his own medical decisions, even if they are delusional. Of course, in psychiatry delusions are defined as fixed beliefs that are certainly and definitely false, but not beliefs that are ordinarily accepted by other members of the person's culture or subculture. Any way of thinking that needs a qualification like that should give one pause.

Enough, Really

I hate to say that I became jaded with the ER over the course of the month, but I really did. Maybe it was the lady who came in with allergic conjunctivitis. Her eyes had been kind of itchy for three days, no vision changes, no pain. She was using visine and it seemed to help. Not quite an emergency and nothing we can really do. Next. Or maybe it was the guy I saw at 2 am a few days ago who said his car had been side swiped and his right hand crushed because he had been sticking it out the window. He had wrist drop, radial nerve injury findings, and a little swelling, but the hand didn't look that hurt. The mystery deepened when X-rays didn't show any fractures or dislocations or anything. It took an orthopedics consult going back and grilling him twice for him to admit that he just fell asleep in his car with his arm out the window and when he woke up he couldn't use his wrist. Classic case of Saturday Night Palsy. I felt a little bad I didn't pick up on it earlier, but when a patient is blatantly lying to you, what are you going to do? I think the last straw was the woman who came in with bruising on her hand and said she had dropped a cabinet on it. I was super sympathetic, she had a definite injury, but then my attending was like, "oh, I know that lady". Apparently she was a frequent customer and judging from her INSPECT report she got several prescriptions for narcotics from different ERs around the area every month for back strain, neck strain, bruising, etc. etc. Sigh. I just want to go back to peds where I can deal with pushy parents and not worry about patients seeking drugs at least until they are teenagers.

Of course, there were some interesting patients too. The schizophrenic patient who said a demon named "Terry" had taken his finger and twisted it around three times. Sure enough, he had a spiral fracture of his third digit. He was off his meds so I think the world will never know whether he did it to himself, someone else assaulted him, or it really was "Terry". I also had a really sweet, old, confused lady with metastatic lung cancer and a giant plural effusion making it hard for her to breathe. I got to do a thoracentesis and drain all the fluid off her lung which was fun for me and a big help to her. Score. Then there was the other sad patient who had a 75 pound unintentional weight loss over the past 7 months. Totally emaciated, easy bruising, feeling horrible, and he just didn't want to go to the doctor. I had to leave before I got to see his lab results, but I think he most likely has cancer till proven otherwise. Really nice guy, and really sad. That's another thing I like about peds...I feel like even the most negligent parents would bring their kid in to a doctor well before they lost a third of their body weight. Please, if you have sudden weight loss for no apparent reason, go see your doctor!

I think this video says it best. Goodbye ER. Good short term experience. Not for me.